National Provider Identifier Database

MAPLE STREET CLINIC PHARMACY LLC
Clinic Pharmacy

A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.


Contact Information

MAPLE STREET CLINIC PHARMACY LLC
1825 MAPLE ST
FOREST GROVE, OR97116-1939
Phone: 503-357-7552
Fax: 503-359-5071
Website:
Specialty Taxonomy Code
* Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X

* Indicates primary specialty

NPI Profile & details for MAPLE STREET CLINIC PHARMACY LLC

NPI Number 1912064478
Legal business name
LBN
MAPLE STREET CLINIC PHARMACY LLC
Authorized official CHRISTOPHER VORRATH - (PRES)
Entity Organization
Organization subpart No
Enumeration date 01/03/2007
Last updated 06/23/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • OR License #: RP0000674CS
  • OR Medicaid: 0003280
  • Other: 3810163 OTHER ID NUMBER
  • Other: 3810163 OTHER ID NUMBER-COMMERCIAL NUMBER

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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